Form Ftb 3861a C1 - Bank And Corporation - Statement Of Financial Condition And Other Information Page 8
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83. Disposal of assets – From the beginning of the taxable period covered by this offer in compromise to the present date, has there been a
disposition of any assets or property with a cost or fair market value of more than $500, except for full value at the time of sale, transfer,
exchange, gift or other disposition?
No
Yes (If yes, please furnish the following information.)
Date of
Fair Market Value
Consideration
Relationship of Transferee
Description of Asset
Transfer
When Transferred
Received
to Taxpayer
$
$
4. Are there any other assets or an interest in assets either actual or contingent, other than those listed here?
No
Yes (If yes, please describe the assets.)
5a. Are foreclosure proceedings
b. If yes, please give location of real estate.
c. Was the government made
pending on any real estate
a party to the suit?
which the corporation owes
or has an interest in?
No
Yes
No
Yes
6a. Are bankruptcy or receivership proceedings pending?
b. Is it in process of liquidation?
No
Yes
No
Yes
7. What is the prospect of an increase in value of assets or in present income? (Please give general statement.)
8. Documentation
You must submit the following documentation with your offer. Your offer will be denied if you do not submit all the required documentation.
a. Bank information:
•
Bank statements for all accounts held for the past twelve months.
•
Final statements for any accounts closed within the past two years.
b. Lease(s) or rental agreement(s):
•
Copies of lease(s)/rental agreement(s) either as landlord or tenant.
c. Vehicle information:
•
Copies of loan/lease statements for any vehicles.
d. Offers in compromise to the IRS:
•
Copies of any offers in compromise made to the IRS.
•
Copies of any correspondence from the IRS indicating what action they have taken on the offer to date.
e. Real property:
•
Copy of the most recent statement for each loan.
•
Copy of any listing contracts for property currently listed for sale.
•
Copies of deeds and any related documents for any real property sold, given away or foreclosed upon in the past five years.
9.
Affidavit
Under penalties of perjury, I declare that I have examined the information given in this statement and, to the best of my knowledge and belief, it is
true, correct, and complete, and I further declare that there are no assets, owned either directly or indirectly, or income of any nature other than as
shown in this statement.
a. Date of this statement
b. Signature
c. Title
FTB 3861A C1 (REV 11-94) PAGE 8
PAGE 14
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